On Tuesday, November 17 HC3 hosted State of Legislation Part II, focusing on federal policy. The event, which is as part of HC3’s ongoing Transformation Series, featured a discussion with public and private sector leaders about the outcomes from the November 3rd elections, potential solutions that could stimulate the economy, and developing an equitable path forward for our local communities.
Stephanie Altman, Director of Healthcare Justice, Senior Director of Policy, Shriver Center on Poverty Law
David Smith, Co-Founder and CEO, Third Horizon Strategies and Co-Founder, HC3
Vikki Wachino, Former Deputy Administrator, CMS and Director, Center for Medicaid and CHIP Services
David Johnson, Founder and CEO 4Sight Health
Watch the Recap | Link to YouTube
Through her work at the Shriver Center, Stephanie is focused on representing low-income people in Illinois and addressing health disparities, primarily through coverage opportunities. Stephanie is hopeful for more equal access to providers and continues to concentrate on stopping “ACA sabotage” as a means to address health and racial inequities.
The ACA has created a strong foundation for coverage in the United States. Opportunities for improvement include coverage and affordability. Especially at this moment in time, every part of the system has a role to play in doing a better job with the pandemic response. There is a lot to reverse from the damage of the current administration over the past four years. With the rise of awareness around racial inequities, there needs to be more systemic changes to address this very prominent issue.
The transition of power from President Trump to President-elect Biden will be muddled and will delay much needed leadership and policy from the new administration. There is no clear path for a progressive agenda. The margin for leftist policies will be thin, even if the Senate ends up evenly split. The continuations of COVID-19 and economic fires will continue to burn through next summer despite how quickly we manufacture a vaccine or pass additional federal aid.
There are three core challenges as we head into January. First, the Medicare is projected to reach insolvency in 2024, meaning that the new administration will be in office during the period when Medicare Trust Fund will run out of money. Second, states are facing an increasingly dire budget climate. Illinois alone is staring down a $6 billion deficit because the Fair Tax Act failed to pass. Third, the health care delivery system took a $320 billion hit amid COVID-19 and is still “financially battered.”
Price transparency, telehealth parity, interoperability, as well as a continued push for values-based payments will likely be a strong a focus. Major changes to social compact will occur, though we don’t exactly how because we don’t know the full extent to which it has shifted.
David Johnson (DJ): Will the Republican Party start to shift towards a more working-class party? What will the U.S. look like for the next four years?
VW: The voting process was smooth – there were hints that violence, protests, and unrest could erupt, but everything remained relatively neutral. It seems like there might be more of middle ground in health care legislation than now. The D.C. atmosphere is more bipartisan than one would assume, and we just need the right key to unlock its potential.
SA: The working class extends beyond groups that voted for Trump.
DJ: Where are we in the journey to providing affordable health care in our country?
DS: A business case has been built to address social determinants of health, health inequities, and racism. Businesses cannot remain absolved from the activities that can lift communities up. We have plenty of resources (i.e., venture-backed tech, innovation), we just haven’t done a good job of putting it towards underserved communities. There are opportunities to do better.
VW: A strong base of coverage is necessary to stop health inequity. All states need to accept Medicaid expansion, and some progress is happening in this regard. We all have a long way to go to in dealing with racism in health care. There needs to be a long-term commitment to figure out how to serve communities that have been underinvested in for a long time. The quality of information and data will be key in getting past some of our divisions.
SA: Coverage is the first priority, but not the end solution to achieving equity. Medicaid expansion is a strategy to try to reach racial equity. Immigrant communities, which are primarily communities of color, are often treated differently so it really is a racial equity issue. A strong focus should be on improving health care for immigrants. Illinois has made progress by extending Medicaid for 12 months post-partum in the state, but we need to provide other birth support. Illinois also started a program to offer coverage for seniors 65+ regardless of their immigration status.
DJ: How can we improve and align the distribution of resources at all levels in a more equitable manner to improve social determinants of health? DS: States are going to continue to be challenged with budget issues due to the pandemic. States play a critical role in addressing resource distribution challenges. States are going to have to engineer ways to solve their budgetary challenges, which may include coordinating different initiatives to impact holistic health. There is going to be a much higher expectation to orient resources towards whole-person care moving forward.
VW: There are communities that have not had a lot of investment for health care and hospitals. And no one has figured out the right way to invest in disenfranchised communities, nor how to go about addressing the issue of expenses being concentrated in larger systems. There is no puppeteer behind that scenes that can move resources around to the areas in most need.
There was reluctance by the federal government to support states during the pandemic, especially during the second half of the year. There was a “distinct lack of sympathy for states.” In order for states to play a bigger role in improving social determinants of health, ultimately “the federal government needs to step up fiscally.”
SA: We may not know exactly what works, but we know where to start. Housing is a prime example of where we can start. Medicaid and housing go hand-in-hand. Having a job, safe workplace, and basic income contribute to overall health. Income disparities need to be addressed to reduce a range of inequities, and that starts with providing universal basic income.
DJ: Any last thoughts or predictions?
VW: We will continue to focus more strongly on delivery system reform and driving interoperability. There is a real opportunity to bring racial equity to the delivery system.
DS: Economic pressure, changes to the social compact, and a new tech foundation will collide to define the next generation of the U.S.’s health care ecosystem. The implications of what happens in the market and how the government regulates it will direct the future of equity.
SA: Universal basic income is one of the next frontiers in reducing income disparities and racial equity.